Entre Nous: the European magazine for sexual and reproductive health: no. 60: maternal and newborn health: every mother and child counts

MATERNAL AND NEWBORN HEALTH: EVERY MOTHER AND CHILD COUNTS EntreNous The European Magazine for Sexual and Reproductive Health Entre Nous is published by: Reproductive Health and Research Programme WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen 0 Denmark Tel: (+45) 3917 1341 Fax: (+45) 3917 1850 E-mail: entrenous@who.dk www.euro.who.inVentrenous Chief e ditor Dr Gunta Lazdane Editor Jeffrey V. Lazarus Editorial assistant Dominique Gundelach Layout To om bord, Denmark. www.toombord.dk Print Central tryk Hobro a/s Entre Nous is funded by the United Nations Population Fund (UNFPA), New York, with the assistance of the World Health Organization Regional Office for Europe. Copenhagen, Denmark. It is published three times a year. Present distri­ bution figures stand at: 3,000 English, 2,000 Spanish, 2,000 Portuguese. 1,000 Bulgarian, 1,000 Russian and 500 Hungarian. Entre Nous is produced in: Bulgarian by the Ministry of Health in Bulgaria as a part of a UNFPA-funded project; Hungarian by the Department of Obstetrics and Gynaecology. University Medial School of Debrecen, PO Box 37, Debrecen, Hungary; Portuguese by the General Directorate for Health, Alameda Afonso Henriques 45, P-1056 Lisbon, Portugal; Russian by the WHO Information Centre for Health for the Central Asian Republics; Spanish by the lnstituto de la Mujer, Ministerio de T rabajo y Asuntos Social es, Almagro 36, ES-28010 Madrid, Spain. The Portuguese and Spanish issues are distri­ buted directly through UNFPA representatives and WHO regional offices to Portuguese and Spanish speaking countries in Africa and South America. Material from Entre Nous may be freely translat­ ed into any national language and reprinted in journals, magazines and newspapers or placed on the Web provided due acknowledgement is made to Entre Nous, UNFPA and the WHO Regional Office for Europe. Articles appearing in Entre Nous do not necessarily reflect the views of UNFPA or WHO. Please address enquiries to the authors of the signed articles. For information on WHO-supported activities and WHO documents, please contact the Family and Community Health unit at the address given above. Please order WHO publications directly from the WHO sales agent in each country or from Marketing and Dissemination, WHO, CH-1211, Geneva 27, Switzerland ISSN: 1014-8485 © World Health Organization 2005 CONTENTS Editorial By Marc Danzon 3 Making Pregnancy Safer in the European Region Challenges and the way forward By Alberta Bacci 4 Children's and adolescents' health in Europe By Mikael fJstergren and Vivian Barnekow Rasmussen 6 Integrated Management of Childhood Illness Strategy: Improving Child Care, Health and Development in Families and Communities By Aigul Kuttumuratova 8 Strategic framework for the prevention of HIV infection in infants in Europe: The opportunity for virtual elimination By Ruslan Ma/yuta 10 Improving the quality of perinatal care with professional distance training By Anna Berglund, Martha Garrett. Gunilla Lindmark 12 Action for the global elimination of congenital syphilis By George Schmid, Ulrich Laukamm-Josten. Sarah Hawkes and Nathalie Broutet 15 The role of midwives in mother and newborn care By Dalia Jeckaite Assessment of maternity practice in the Republic of Moldova By Petru Stratulat. Valentina Ba/tag, Ala Curteanu, Tatiana Caraush Promoting equity in reproductive health By Giorgio Tamburlini Newborn health care still deficient in the European Region By Gian Paolo Chiaffoni Perinatal care in Lithuania By Gelmius Siupsinskas and Arunas Liubsys 18 20 22 25 28 The environmental burden of disease and injury among children and adolescents in Europe 30 Resources 31 Page 5 Page9 Page 13 Page 31 Cover illustration The tangram on the cover was designed for World Health Day 2005 by Qu1m Martell THE ENTRE NOUS EDITORIAL ADVISORY BOARD Dr Assia Brandrup­ Lukanow Director, Division for Health, Education and Social Protection German Agency for Technical Co­ operation (GTZ) Mr Bjarne B. Christensen Head of secretariat, Sex & Samfund, the Danish Member Association of IPPF Dr Helle Karro Head, Department of Obstetrics and Gynaecology. Medical Faculty. University of Tartu, Estonia Dr Evert Ketting Netherlands School of Public and Occupational Health Utrecht, The Netherlands Dr Malika Ladjali Senior Programme Specialist UNESCO/Headquarters, Paris Ms Adriane Martin Hilber Technical Officer, Department of Reproductive Health and Research, WHO Headquarters, Geneva Ms Nell Rasmussen LLM Director, PRO-Centret, Copenhagen Dr Peer Sieben UNFPA Representative and Country Director, Romania Ms Vicky Claeys Regional Director International Planned Parenthood Federation, European Network (IPPF-EN). Brussels Dr Robert Thomson Adviser on Sexuality. Reproductive Health & Advocacy. UNFPA Country Technical Services Team for Europe, Bratislava EDITORIAL Every mother and child counts The international community has clearly articulated its commitment to make pregnancy and childbirth safer in numer­ ous internal conferences and documents, such as the International Conference on Population and Development (Cairo, 1994), the Fourth World Conference on Women (Beijing, 1995) and more recently within the Millennium Development Goals. Vet the problems persist, with vast differences between and within countries. ....i, n •·• ....... .......,..."\ ..... � r-: w.ia,. --""'l' That is why this year, World Health Day - celebrated on 7 April. the day the World Health Organization's constitution was signed in 1948 - will specifically address the health of mothers and children. We know that when a mother dies. their entire family is affected, especially the youngest children. who are at a greater risk of becoming ill. And, as described in this year's World Health Report, entitled "make every mother and child count", we also know what to do. Every minute, a woman dies in the world from complications in pregnancy and childbirth, which results in more than half a million maternal deaths every year. Many millions more suffer disabili­ ties. More than 10 million children die each year and newborn babies less than one month old are at greatest risk. And while most of these deaths take place in the poorest countries and regions of the world, the European Region of WHO is also affected. The officially reported maternal death rate in the central Asian republics in 2001 was 41 per 100 000 live births, while it was 5 per 100 000 in the European Union countries in the same year. Although child mortality is decreas­ ing in general, several countries in the Region still have high mortality rates and the probability that a child will not reach 5 years of age varies from 3 to 50 per 1000 live births . In 1999, a new WHO Cabinet project in the field of reproductive health, "Making Pregnancy Safer" (MPS), was launched. This initiative aims at identify­ ing the key interventions in decreasing maternal morbidity and mortality world­ wide. In 2001. the WHO Regional Office for Europe published the WHO European Regional Strategy on Sexual and Reproductive Health, which has been used by several Member States as strate­ gic guidance in the development of poli­ cies towards improving the reproductive health of their populations. MPS is the first goal in most of these national policy documents and to meet the needs of the countries. an MPS project was launched in the European Region. Additionally. the 2003 meeting of WHO's European Regional Committee established child and adolescent health and development at a top priority and the Regional Office was charged with the responsibility for developing a European No. 60 - 2005 By Marc Danzon "Strategy for Child and Adolescent Health and Development" that will be presented to the 55th Session of the Regional Committee in 2005. In May 2004, the 57th World Health Assembly adopted the global "Repro­ ductive health strategy: to accelerate progress towards the attainment of inter­ national development goals and targets" and once more reminded the interna­ tional community of the specific targets of the Millennium Development Goals to reduce by three quarters, between 1990 and 2015. the maternal mortality ratio; to reduce by two thirds, between 1990 and 2015. the under-five mortality rate; and to have halted by 2015, and begun to reverse, the spread of HIV I AIDS. Member States have asked WHO Regional Office for Europe to provide concrete directions for the accelerated improvement of maternal and newborn quality care and the reduction of mater­ nal and newborn morbidity and mortali­ ty. The purpose of the Making Pregnancy Safer regional strategy is to provide direc­ tions to countries for the accelerated improvement of maternal and newborn quality care and the reduction of mater­ nal and newborn morbidity and mortali­ ty. The strategy will be discussed by the Member States this year. All these topics and ways to reach our goals are covered in this issue of Entre Nous. We hope these vital public health problems affecting the lives of every mother and child will be discussed and solved by the readers. Let me conclude by expressing my wish that World Health Day 2005 act as the catalyst that will renew all of our efforts to improve the situation of women and children in need. Marc Danzon Regional Director WHO Regional Office for Europe 3